unicompartmental knee prosthesis indications. n. confalonieri orthopaedic department orthopaedic and...
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N. CONFALONIERIN. CONFALONIERI
ORTHOPAEDIC ORTHOPAEDIC DEPARTMENTDEPARTMENT
ORTHOPAEDIC AND ORTHOPAEDIC AND TRAUMATOLOGIC CENTERTRAUMATOLOGIC CENTER
MILANMILAN
-Patients selection-Patients selection-Operative techniques-Operative techniques-Prosthetic design-Prosthetic design-Few complications-Few complications
INDICATIONS:INDICATIONS:
• Unicomp. arthrosisUnicomp. arthrosis• Intact controlateral compartmentIntact controlateral compartment
• (Ist and 2d Ahlback’s classes) (Ist and 2d Ahlback’s classes)
• Asimptomatic patellofemoral jointAsimptomatic patellofemoral joint
• ROM > 90°ROM > 90°
• Axial deformity < 15° Axial deformity < 15°
INDICATIONS:INDICATIONS:
• Flexion deformity < 5°Flexion deformity < 5°
• Age > 60 y.Age > 60 y.
• Body Weight: < 82 kgBody Weight: < 82 kg
• No joint laxity (intact ACL) No joint laxity (intact ACL)
• No pain at restNo pain at rest
• No systemic disordersNo systemic disorders
(reumathoid arthr., hemophilia)(reumathoid arthr., hemophilia)
UNICOMPARTMENTAL UNICOMPARTMENTAL KNEE PROSTHESISKNEE PROSTHESIS
RELATIVE CONCEPT !RELATIVE CONCEPT !
UNICOMPARTMENTAL UNICOMPARTMENTAL KNEE PROSTHESISKNEE PROSTHESIS
PATELLOFEMORAL PATELLOFEMORAL JOINT ?JOINT ?
UNICOMPARTMENTAL UNICOMPARTMENTAL KNEE PROSTHESISKNEE PROSTHESIS
TO BE EVALUATED IN TO BE EVALUATED IN EACH CASEEACH CASE
UNICOMPARTMENTAL UNICOMPARTMENTAL KNEE PROSTHESISKNEE PROSTHESIS
ACCORDING TO AGE ACCORDING TO AGE AND ACTIVITYAND ACTIVITY
UNICOMPARTMENTAL UNICOMPARTMENTAL KNEE PROSTHESISKNEE PROSTHESIS
RELATIVE CONCEPT !RELATIVE CONCEPT !
UNICOMPARTMENTAL UNICOMPARTMENTAL KNEE PROSTHESISKNEE PROSTHESIS
CONTROINDICATIONS:CONTROINDICATIONS:
• Flexion deformity > 15°Flexion deformity > 15°
• Osteoporosis + Obesity + DeformityOsteoporosis + Obesity + Deformity
• Technical errors: - polyetylene < 6 mmTechnical errors: - polyetylene < 6 mm
• - ipercorrection- ipercorrection
• - hip disease- hip disease
UNICOMPARTMENTAL UNICOMPARTMENTAL KNEE PROSTHESISKNEE PROSTHESIS
CONTROINDICATIONS:CONTROINDICATIONS:
• Reumathoid arthr., HemophiliaReumathoid arthr., Hemophilia
• Serious joint laxitySerious joint laxity
• Serious varus deformitySerious varus deformity
• Serious Serious symptomaticsymptomatic patello-femoral patello-femoral
arthritis arthritis
-Patients selection-Patients selection-Operative techniques-Operative techniques-Prosthetic design-Prosthetic design-Few complications-Few complications
-Patients selection-Patients selection-Operative techniques-Operative techniques-Prosthetic design-Prosthetic design-Few complications-Few complications
-Patients selection-Patients selection-Operative techniques-Operative techniques-Prosthetic design-Prosthetic design-Few complications-Few complications
COMPLICATIONSCOMPLICATIONS• DVT: DVT: 44 (1.8%) (1.8%)
• CONDILE FRACTURES: CONDILE FRACTURES: 1 tibial1 tibial (0.4%) (0.4%)
• 1 femoral1 femoral (0.4%) (0.4%)
• SUPERFICIAL INFECTIONS: SUPERFICIAL INFECTIONS: 6 6 (2.8%) (2.8%)
• SYNOVITIS: SYNOVITIS: 3 3 (1.1%) (1.1%)
UNICOMPARTMENTAL UNICOMPARTMENTAL KNEE PROSTHESISKNEE PROSTHESIS1988 - 2000: 1988 - 2000: 211 cases211 cases
Scala sensorizzataScala sensorizzata
staircase
handrailing
platform
instrumentedsteps
Instrumented Staircase
for Ground Reaction Measurement
Robert Riener1,2, Marco Rabuffetti1,
Carlo Frigo1, Jochen Quintern3, Günther Schmidt2
Descent Descent Uni fixed bearingUni fixed bearing (K,1148)(K,1148)
Normal dynamic and videomatic Normal dynamic and videomatic (cynematic)(cynematic)
0 20 40 60 80 100-5
-4
-3
-2
-1
0
1
% Stride duration Abs stride duration (Normal:1.21 s) (Subject:1.29 s)
Ab
s. W
/Kg
G
en.
Subject : K (#1148) Direction : DOWN KneePower
Normal FixedPlateauUntreated
0 20 40 60 80 100-1.6
-1.4
-1.2
-1
-0.8
-0.6
-0.4
-0.2
0
0.2
% Stride duration Abs stride duration (Normal:1.21 s) (Subject:1.29 s)
Flx
. N
/Kg
E
xt.
Subject : K (#1148) Direction : DOWN KneeMoment
Normal FixedPlateauUntreated
0 20 40 60 80 10010
20
30
40
50
60
70
80
90
100
% Stride duration Abs stride duration (Normal:1.27 s) (Subject:1.29 s)
Ext
. d
eg
F
lx.
Subject : K (#1148) Direction : DOWN KneeAngle
Normal FixedPlateauUntreated
Potenza
Momento
Angolo
CONCLUSIONSCONCLUSIONS
Most patients with UKA walked with a Most patients with UKA walked with a more normal gait pattern than patients more normal gait pattern than patients
with TKA.with TKA.Some worrisome radiographic findings Some worrisome radiographic findings
will require careful long term will require careful long term evalutation to assess UKA longevity and evalutation to assess UKA longevity and
utility.utility.
J.O. Galante (1996)J.O. Galante (1996)